When the Nurse is a Bully

SAUSALITO, CA (ASRN.ORG) -- It was the end of my shift, and I listened as one of my co-workers was being hassled over the phone for the second time that day. The computer wouldn’t release a patient record, and a nurse in another department was blaming her.

Nurses eat their young. The expression is standard lore among nurses, and it means bullying, harassment, whatever you want to call it. It’s that harsh, sometimes abusive treatment of new nurses that is entrenched on some hospital floors and schools of nursing. It’s the dirty little secret of nursing, and it needs to be publicly acknowledged, and just as publicly discussed, because it’s keeping us down.

The phrase was on my mind that shift, because earlier in the day, a nursing student on the floor had told me about the time she had to make an emergency room visit because of kidney stones, which made her late with a class assignment. Despite a doctor’s note, her nursing instructor didn’t accept the excuse, telling her, “You need to make better life choices.”

I’ve heard similar stories coast to coast, and I’ve experienced hostile treatment myself. In my first nursing job, some of the more senior nurses on the floor lied about work I had or hadn’t done, refused to help me at times when I really needed it, and corrected my inevitable mistakes loudly and whenever possible, in public. By the time I left, I felt like I had a huge bull’s-eye on my back, and once I became a target, it was difficult to be an effective nurse.

Ms. Bartholomew, a Nurse Consultant notes that because nursing “has its fundamental roots in caring,” it’s often hard for nurses to admit that they could be hurting one another. But studies show that 60 percent of new nurses leave their first position within six months because of some form of verbal abuse or harsh treatment from a colleague.

The nurses in my present job treat one another with respect and compassion, and I couldn’t get through my shifts without their support. But in my hospital and in others where I’ve worked, I have seen a petty meanness in how some nurses interact with one another, and with other hospital staff members.

The technical term for such behavior is “horizontal violence.” We all know that nurse. It’s the one who picks a fight with an I.C.U. nurse in front of a patient who, frightened and suddenly struggling to breathe, is on his way to intensive care. It’s the nurse who insists on calling repeatedly to ask why you haven’t done something — given a drug, started a transfusion — a task that, for a number of valid reasons, you haven’t been able to complete. It’s the nurse who boasts about giving a hard time to the interns — the doctors in training — and makes clear how enjoyable it was to pick on them.

Are most nurses like this? Of course not. But it’s a common enough problem that a search in Google or the medical journal database PubMed will turn up academic studies on the phrases “nurses eat their young,” “ “bullying in nursing,” and “ nursing and horizontal violence.”

Floor nursing is a hard job, in part because shifts are so unpredictable. Stable patients can become unstable in the blink of an eye. The portable phones we carry ring constantly and insistently. The timing of tests, procedures and scans is rarely coordinated with other aspects of care. And a staff absence requires the nurses on the floor to pick up the slack by taking extra patients.

Doctors, I have to admit, can also be rude. Phrases like, “Why are you calling me?” “We’ll get to it when we get to it,” and “That’s not important” are undermining and disheartening because they shut down doctor-nurse communication. I don’t hear such phrases often at work, but I have heard them, and they make coordinating patient care difficult.

Spending our shifts feeling pulled in an impossible number of directions, day after day after day, can in the end be too much. A lot of nurses find a way to regroup and stay, while some burn out and quit. But a few nurses will, like cornered animals, bare their teeth and fight back.

The problem is that they don’t fight back against the people who put them in the corner. These overwhelmed and angry nurses take their frustration out on the rest of us stuck in the corner with them, or on anyone — like interns — they perceive as being less powerful than they are.

The nurse researchers Cheryl Woelfle and Ruth McCaffrey speculate on why nurses attack their own in their article “Nurse on Nurse.” “Nurses often lack autonomy, accountability and control over their profession,” they write. “This can often result in displaced and self-destructive aggression within the oppressed group.”

A big problem with remedying nurse-on-nurse hostility is that although it happens, nurses don’t like to talk about it openly.

“It is embarrassing and so remotely removed from our idea of the perfect nurse that we shudder to think it may be true,’’ writes Ms. Bartholomew. “There is an unspoken fear, warranted or not, that acknowledging the problem will make it worse.’’

Ms. Bartholomew argues that the best antidote is open discussion, and I agree. A majority of nurses do not bully on the job, and that majority needs to set a new tone. We have to come out of the corner, stop allowing our co-workers to tear at one another’s flesh and instead speak up. We obviously have a lot on our minds.

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